Few big scientific ideas are so widely adopted and understood as the concept of the paradigm shift.1 Robert Brook, one of the founders of the quality improvement paradigm, in a recent article entitled, The End of the Quality Improvement Movement: Long Live Improving Value, described incisively the latest big paradigm shift that has arisen as a consequence of the economic imperatives challenging health systems globally.2

Quality, safety, and evidence of effectiveness in medical care—the previous paradigms—are still essential, but only in so far as they affect value. Consideration of value is what lies at the heart of a new report by IMPRESS (Improving and Integrating Respiratory Services)3—a collaboration between respiratory specialists and generalists with a special interest in lung health. The report calculated the relative value of different interventions within a particular system of healthcare: services for patients with chronic obstructive pulmonary disease (COPD).

Value relates the outcomes of healthcare interventions to their cost. Costs are considered not only in terms of money or carbon, but …